Acute hepatitis in children: A wide clinical spectrum

Introduction: Acute hepatitis remains an important health problem in children. viral hepatitis particularly hepatitis A remains the most common cause. Nevertheless, other causes such as non A non B hepatitis and mixed infections like enteric fever are other causes particularly in developing countries like India. The spectrum of acute hepatitis is also varied with many atypical presentations in the form of fever along with icterus as presenting features. Use of lab parameters as prognostic markers for development of acute liver failure (ALF) needs further exploration as it can be used to identify patients who need better monitoring and may be the potential candidates for liver transplantation. In our study we have tried to find a possible association between liver enzyme values and number of children who develop ALF.

Methods: Children between 1 and 15 years of age who presented with features of acute hepatitis were enrolled in the study after taking informed consent from their parents. Data was collected about their epidemiological and clinical characteristics in a predesigned study performa. Quantitative data were described as means and standard deviations and qualitative data were computed into frequency (No) and percentages (%). Chi-square (χ2) test was used to determine the statistical difference between the categorical variables, while means were compared using student’s t test. For all statistical analyses, p value < 0.05 was adopted as level of significance.

Results: We enrolled 68 patients of acute hepatitis. Most of them were males (78%) and majority were in 6 to 10 years age category. The most common clinical presentation was with abdominal pain followed by fever and icterus. Liver enzymes were raised to the tune of 10 to 20 times in the second week of illness. Serum bilirubin mean value was 5.3. Serum bilirubin values remained almost constant over 3 weeks period while liver enzymes showed a decline. 26% patients presented with ALF. Also, liver enzyme values in the second week showed a positive association with development of ALF with higher values associated with a higher chance of development of ALF.

Conclusion: Hepatitis A was the most important cause of acute hepatitis in children and albeit early, a significant proportion of them develop features of ALF. Regular monitoring of liver enzymes can serve as a prognostic marker for development of ALF. It requires larger level studies to use liver enzymes as prognostic markers of ALF in paediatric patients.